Provider Demographics
NPI:1912942582
Name:ALZOHAILI, OPADA (MD)
Entity Type:Individual
Prefix:DR
First Name:OPADA
Middle Name:
Last Name:ALZOHAILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 AUTO CLUB DR
Mailing Address - Street 2:STE 200
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2619
Mailing Address - Country:US
Mailing Address - Phone:313-914-5591
Mailing Address - Fax:313-914-5580
Practice Address - Street 1:5250 AUTO CLUB DR
Practice Address - Street 2:STE 200
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2619
Practice Address - Country:US
Practice Address - Phone:313-914-5591
Practice Address - Fax:313-914-5580
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-074590207R00000X
MI4301065354207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2147573Medicaid
OH2147573Medicaid
OHH10783Medicare UPIN